Antethoracic Pedicled Jejunum Reconstruction with the Supercharge Technique for Esophageal Cancer

Iwata, Nakao; Koike, Masahiko; Kamei, Yuzuru; Tanaka, Chie; Ohashi, Norifumi; Nakayama, Goro; Nomoto, Shuji; Fujii, Tsutomu; Sugimoto, Hiroyuki; Fujiwara, Michitaka; Kodera, Yasuhiro

doi:10.1007/s00268-012-1736-4

Cited by 25 publications

(9 citation statements)

References 38 publications

(47 reference statements)

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“…Another important issue in secondary esophageal reconstruction is external coverage of the reconstructed conduit. In these high‐risk patients, the subcutaneous route is usually employed to prevent the lethal complications resulting from flap necrosis or anastomotic leakage . Primary closure is often complicated by scar formation and fibrosis of the surrounding skin.…”

Section: Discussionmentioning

confidence: 99%

Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction

et al. 2013

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Secondary reconstruction of thoracic esophageal defects is a challenging problem for microsurgeons. Because of previous surgeries and coexisting disease, gastric pull-up, and creation of a pedicled colon conduit are often impossible. Transfer of a supercharged pedicled jejunum flap or free jejunal interposition is usually the last resort; however, identifying appropriate recipient vessels and adequately covering the reconstructive conduit are often difficult. We performed secondary thoracic esophageal reconstruction with combined use of the cephalic vein as a recipient vein and the pectoralis major muscle flap for coverage in three patients. Two patients underwent transfer of a supercharged pedicled jejunum flap, and the other patient underwent free jejunal interposition. No wound complications occurred, and all patients could resume oral intake. The cephalic vein is a more reliable recipient vein than is the internal mammary vein. The skin graft-covered pectoralis major muscle flap provides secure external coverage to prevent anastomotic leakage even in complicated cases. Combined use of the cephalic vein and the skin graft-covered pectoralis major muscle flap is a versatile option for secondary thoracic esophageal reconstruction.

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Section: Discussionmentioning

confidence: 99%

Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction

et al. 2013

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“…A variety of cases series describing institutional experience with supercharged jejunal conduits and detailed results of these series are summarized in Table 2 (10,14,22,25,(27)(28)(29)(30)(31)(32). Post-operatively, the reported rates of graft loss ranged from 0-8%.…”

Section: Resultsmentioning

confidence: 99%

“…In certain instances, jejunal conduits may not be long enough to reach the hypopharynx. Fatty mesentery may also inhibit the surgeon's ability to pull up the conduit (25).…”

Section: Jejunummentioning

confidence: 99%

Alternative conduits for esophageal replacement

Bakshi

Sugarbaker

Burt

2017

Ann. Cardiothorac. Surg.

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Replacement of the native esophagus after esophagectomy is a problem that has challenged surgeons for over a century. Not only must the conduit be long enough to bridge the distance between the cervical esophagus and the abdomen, it must also have a reliable vascular supply and be sufficiently functional to allow for deglutition.The stomach, jejunum, and colon (right, left or transverse) have all been proposed as potential solutions.The stomach has gained favor for its length, reliable vascular supply and need for only a single anastomosis.However, there are times when the stomach is unavailable for use as a conduit. It is in these instances that an esophageal surgeon must have an alternative conduit in their armamentarium. In this paper, we will briefly discuss the technical aspects of jejunal and colonic interposition. We will review the recent literature with a focus on early and late outcomes. The advantages and disadvantages of both options will be reviewed.

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“…in patients with metachronous or synchronous gastric cancer). We performed colon interposition with isoperistaltic transverse colon grafting based on the left colic artery and marginal arcade, a technique developed in the early 2000s; during the last two decades, we have performed antethoracic pedicled jejunal reconstruction with microvascular anastomoses …”

Section: Methodsmentioning

confidence: 99%

“…We performed colon interposition with isoperistaltic transverse colon grafting based on the left colic artery and marginal arcade, a technique developed in the early 2000s; during the last two decades, we have performed antethoracic pedicled jejunal reconstruction with microvascular anastomoses. 13 We considered that not all of the patients had indications for systemic lymph node dissection, and that we should dissect at least the lymph nodes clinically diagnosed as metastasis.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Salvage pharyngolaryngectomy with total esophagectomy following definitive chemoradiotherapy

et al. 2015

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Historically, total pharyngolaryngectomy with total esophagectomy has been the standard radical surgical treatment for synchronous cancer of the thoracoabdominal esophagus and pharyngolaryngeal region, and for cancer of the cervical esophagus that has invaded as far as the thoracic esophagus. Although definitive chemoradiotherapy that enables preservation of the larynx has often been the first choice of treatment for cancers involving the cervical esophagus, total pharyngolaryngectomy with total esophagectomy is required as a salvage therapy for cases involving failure of complete remission or locoregional recurrence after chemoradiotherapy. However, salvage esophageal surgery after definitive high-dose chemoradiotherapy is generally associated with high morbidity and mortality. The aim of this study was to examine the short-term outcome of salvage total pharyngolaryngectomy with total esophagectomy. From 2001 to 2014, nine patients underwent salvage total pharyngolaryngectomy with total esophagectomy at the Department of Gastroenterological Surgery, Nagoya University. The mortality and morbidity rates were high at 22% and 89%, respectively. Four patients (44%) developed tracheal necrosis, which in two patients eventually led to lethal hemorrhage. Salvage total pharyngolaryngectomy with total esophagectomy is an uncommon and highly demanding surgical procedure that should be carefully planned and conducted in selected centers of excellence. Measures must be taken to preserve the tracheal blood supply, thus avoiding fatal complications.

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Antethoracic Pedicled Jejunum Reconstruction with the Supercharge Technique for Esophageal Cancer

Abstract: Although antethoracic pedicled jejunum reconstruction with the supercharge technique is technically demanding, it is a reliable technique and contributes to successful reconstruction after esophagectomy for patients in whom stomach is not available for reconstruction.

Cited by 25 publications

References 38 publications

Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction

Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction

Alternative conduits for esophageal replacement

Salvage pharyngolaryngectomy with total esophagectomy following definitive chemoradiotherapy

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